Provider Demographics
NPI:1760440341
Name:LEDOUX, KARLA (DO)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3019
Practice Address - Country:US
Practice Address - Phone:863-680-7300
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-004892084N0400X
FLOS66542084N0400X
KY040892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100442260Medicaid
NC2014-00489OtherNC LICENSE
KY04089OtherKY LICENSE
NC10713847OtherCAQH PROVIEW
130015409OtherRR MEDICARE
KY04089OtherKY LICENSE
G27208Medicare UPIN